Chapter SPS 182

SPS 182.03 Note Note: Licensed midwives do not possess prescriptive authority. A licensed midwife may legally administer prescription drugs or devices only as an authorized agent of a practitioner with prescriptive authority. For physicians and advanced practice nurses, an agent may administer prescription drugs or devices pursuant to written standing orders and protocols.

SPS 182.03 Note Note: Medical oxygen, 0.5% erythromycin ophthalmic ointment, tetracycline ophthalmic ointment, oxytocin (pitocin), methyl-ergonovine (methergine), injectable vitamin K and RHo (D) immune globulin are prescription drugs. See s. SPS 180.02 (1).

SPS 182.03(3) (3) Indications, dose, administration and duration of treatment. The indications, dose, route of administration and duration of treatment relating to the administration of drugs and procedures identified under sub. (2) are as follows:

- See PDF for table

SPS 182.03(4) (4) Consultation and referral.

SPS 182.03(4)(a) (a) A licensed midwife shall consult with a licensed physician or a licensed certified nurse-midwife providing obstetrical care, whenever there are significant deviations, including abnormal laboratory results, relative to a client’s pregnancy or to a neonate. If a referral to a physician is needed, the licensed midwife shall refer the client to a physician and, if possible, remain in consultation with the physician until resolution of the concern.

SPS 182.03 Note Note: Consultation does not preclude the possibility of an out-of-hospital birth. It is appropriate for the licensed midwife to maintain care of the client to the greatest degree possible, in accordance with the client’s wishes, during the pregnancy and, if possible, during labor, birth and the postpartum period.

SPS 182.03(4)(b) (b) A licensed midwife shall consult with a licensed physician or certified nurse-midwife with regard to any mother who presents with or develops the following risk factors or presents with or develops other risk factors that in the judgment of the licensed midwife warrant consultation:

SPS 182.03(4)(b)1. 1. Antepartum.

SPS 182.03(4)(b)1.a. a. Pregnancy induced hypertension, as evidenced by a blood pressure of 140/90 on 2 occasions greater than 6 hours apart.

SPS 182.03(4)(b)1.b. b. Persistent, severe headaches, epigastric pain or visual disturbances.

SPS 182.03(4)(b)1.c. c. Persistent symptoms of urinary tract infection.

SPS 182.03(4)(b)1.d. d. Significant vaginal bleeding before the onset of labor not associated with uncomplicated spontaneous abortion.

SPS 182.03(4)(b)1.e. e. Rupture of membranes prior to the 37th week gestation.

SPS 182.03(4)(b)1.f. f. Noted abnormal decrease in or cessation of fetal movement.

SPS 182.03(4)(b)1.g. g. Anemia resistant to supplemental therapy.

SPS 182.03(4)(b)1.h. h. Fever of 102° F or 39° C or greater for more than 24 hours.

SPS 182.03(4)(b)1.i. i. Non-vertex presentation after 38 weeks gestation.

SPS 182.03(4)(b)1.j. j. Hyperemisis or significant dehydration.

SPS 182.03(4)(b)1.k. k. Isoimmunization, Rh-negative sensitized, positive titers, or any other positive antibody titer, which may have a detrimental effect on mother or fetus.

SPS 182.03(4)(b)1.L. L. Elevated blood glucose levels unresponsive to dietary management.

SPS 182.03(4)(b)1.m. m. Positive HIV antibody test.

SPS 182.03(4)(b)1.n. n. Primary genital herpes infection in pregnancy.

SPS 182.03(4)(b)1.o. o. Symptoms of malnutrition or anorexia or protracted weight loss or failure to gain weight.

SPS 182.03(4)(b)1.p. p. Suspected deep vein thrombosis.

SPS 182.03(4)(b)1.q. q. Documented placental anomaly or previa.

SPS 182.03(4)(b)1.r. r. Documented low lying placenta in woman with history of previous cesarean delivery.

SPS 182.03(4)(b)1.s. s. Labor prior to the 37th week of gestation.

SPS 182.03(4)(b)1.t. t. History of prior uterine incision.

SPS 182.03(4)(b)1.u. u. Lie other than vertex at term.

SPS 182.03(4)(b)1.v. v. Multiple gestation.

SPS 182.03(4)(b)1.w. w. Known fetal anomalies that may be affected by the site of birth.

SPS 182.03(4)(b)1.x. x. Marked abnormal fetal heart tones.

SPS 182.03(4)(b)1.y. y. Abnormal non-stress test or abnormal biophysical profile.

SPS 182.03(4)(b)1.z. z. Marked or severe poly- or oligo-dydramnios.

SPS 182.03(4)(b)1.za. za. Evidence of intrauterine growth restriction.

SPS 182.03(4)(b)1.zb. zb. Significant abnormal ultrasound findings.

SPS 182.03(4)(b)1.zc. zc. Gestation beyond 42 weeks by reliable confirmed dates.

SPS 182.03(4)(b)2. 2. Intrapartum.

SPS 182.03(4)(b)2.a. a. Rise in blood pressure above baseline, more than 30/15 points or greater than 140/90.

SPS 182.03(4)(b)2.b. b. Persistent, severe headaches, epigastric pain or visual disturbances.

SPS 182.03(4)(b)2.c. c. Significant proteinuria or ketonuria.

SPS 182.03(4)(b)2.d. d. Fever over 100.6° F or 38° C in absence of environmental factors.

SPS 182.03(4)(b)2.e. e. Ruptured membranes without onset of established labor after 18 hours.

SPS 182.03(4)(b)2.f. f. Significant bleeding prior to delivery or any abnormal bleeding, with or without abdominal pain; or evidence of placental abruption.

SPS 182.03(4)(b)2.g. g. Lie not compatible with spontaneous vaginal delivery or unstable fetal lie.

SPS 182.03(4)(b)2.h. h. Failure to progress after 5 hours of active labor or following 2 hours of active second stage labor.

SPS 182.03(4)(b)2.i. i. Signs or symptoms of maternal infection.

SPS 182.03(4)(b)2.j. j. Active genital herpes at onset of labor.

SPS 182.03(4)(b)2.k. k. Fetal heart tones with non-reassuring patterns.

SPS 182.03(4)(b)2.L. L. Signs or symptoms of fetal distress.

SPS 182.03(4)(b)2.m. m. Thick meconium or frank bleeding with birth not imminent.

SPS 182.03(4)(b)2.n. n. Client or licensed midwife desires physician consultation or transfer.

SPS 182.03(4)(b)3. 3. Postpartum.

SPS 182.03(4)(b)3.a. a. Failure to void within 6 hours of birth.

SPS 182.03(4)(b)3.b. b. Signs or symptoms of maternal shock.

SPS 182.03(4)(b)3.c. c. Febrile: 102° F or 39° C and unresponsive to therapy for 12 hours.

SPS 182.03(4)(b)3.d. d. Abnormal lochia or signs or symptoms of uterine sepsis.

SPS 182.03(4)(b)3.e. e. Suspected deep vein thrombosis.

SPS 182.03(4)(b)3.f. f. Signs of clinically significant depression.

SPS 182.03(4)(c) (c) A licensed midwife shall consult with a licensed physician or licensed certified nurse-midwife with regard to any neonate who is born with or develops the following risk factors:

SPS 182.03(4)(c)1. 1. Apgar score of 6 or less at 5 minutes without significant improvement by 10 minutes.

SPS 182.03(4)(c)2. 2. Persistent grunting respirations or retractions.

SPS 182.03(4)(c)3. 3. Persistent cardiac irregularities.

SPS 182.03(4)(c)4. 4. Persistent central cyanosis or pallor.

SPS 182.03(4)(c)5. 5. Persistent lethargy or poor muscle tone.

SPS 182.03(4)(c)6. 6. Abnormal cry.

SPS 182.03(4)(c)7. 7. Birth weight less than 2300 grams.

SPS 182.03(4)(c)8. 8. Jitteriness or seizures.

SPS 182.03(4)(c)9. 9. Jaundice occurring before 24 hours or outside of normal range.

SPS 182.03(4)(c)10. 10. Failure to urinate within 24 hours of birth.

SPS 182.03(4)(c)11. 11. Failure to pass meconium within 48 hours of birth.

SPS 182.03(4)(c)12. 12. Edema.

SPS 182.03(4)(c)13. 13. Prolonged temperature instability.

SPS 182.03(4)(c)14. 14. Significant signs or symptoms of infection.

SPS 182.03(4)(c)15. 15. Significant clinical evidence of glycemic instability.

SPS 182.03(4)(c)16. 16. Abnormal, bulging, or depressed fontanel.

SPS 182.03(4)(c)17. 17. Significant clinical evidence of prematurity.

SPS 182.03(4)(c)18. 18. Medically significant congenital anomalies.

SPS 182.03(4)(c)19. 19. Significant or suspected birth injury.

SPS 182.03(4)(c)20. 20. Persistent inability to suck.

SPS 182.03(4)(c)21. 21. Diminished consciousness.

SPS 182.03(4)(c)22. 22. Clinically significant abnormalities in vital signs, muscle tone or behavior.

SPS 182.03(4)(c)23. 23. Clinically significant color abnormality, cyanotic, or pale or abnormal perfusion.

SPS 182.03(4)(c)24. 24. Abdominal distension or projectile vomiting.

SPS 182.03(4)(c)25. 25. Signs of clinically significant dehydration or failure to thrive.

SPS 182.03(5) (5) Transfer.

SPS 182.03(5)(a) (a) Transport via private vehicle is an acceptable method of transport if it is the most expedient and safest method for accessing medical services. The licensed midwife shall initiate immediate transport according to the licensed midwife’s emergency plan; provide emergency stabilization until emergency medical services arrive or transfer is completed; accompany the client or follow the client to a hospital in a timely fashion; provide pertinent information to the receiving facility and complete an emergency transport record. The following conditions shall require immediate physician notification and emergency transfer to a hospital:

SPS 182.03(5)(a)1. 1. Seizures or unconsciousness.